Provider Demographics
NPI:1285684647
Name:LLOYD, SANDRA (PAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9260
Mailing Address - Country:US
Mailing Address - Phone:402-483-8500
Mailing Address - Fax:402-483-8501
Practice Address - Street 1:4333 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9260
Practice Address - Country:US
Practice Address - Phone:402-483-8500
Practice Address - Fax:402-483-8500
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025250200Medicaid
NE278527Medicare ID - Type Unspecified
NE280639Medicare PIN
NE10025250200Medicaid
NE095928012Medicare PIN